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Cardiopulmonary monitoring of shock

Simmons, Jamesa; Ventetuolo, Corey E.a,b

Current Opinion in Critical Care: June 2017 - Volume 23 - Issue 3 - p 223–231
doi: 10.1097/MCC.0000000000000407
CARDIOPULMONARY MONITORING: Edited by Mitchell M. Levy

Purpose of review We will briefly review the classification of shock and the hallmark features of each subtype. Available modalities for monitoring shock patients will be discussed, along with evidence supporting the use, common pitfalls, and practical considerations of each method.

Recent findings As older, invasive monitoring methods such as the pulmonary artery catheter have fallen out of favor, newer technologies for cardiac output estimation, echocardiography, and noninvasive tests such as passive leg raising have gained popularity. Newer forms of minimally invasive or noninvasive monitoring (such as pulse contour analysis and chest bioreactance) show promise but will need further investigation before they are considered validated for practical use. There remains no ‘ideal’ test or standard of care for cardiopulmonary monitoring of shock patients.

Summary Shock has potentially reversible causes of morbidity and mortality if appropriately diagnosed and managed. Older methods of invasive monitoring have significant limitations but are still critical for managing shock in certain patients and settings. Newer methods are easier to employ, but further validation is needed. Multiple modalities along with careful clinical assessment are often useful in distinguishing shock subtypes. Best practice standards for monitoring should be based on institutional expertise.

aDivision of Pulmonary, Critical Care, and Sleep, Department of Medicine

bDepartment of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, USA

Correspondence to Corey E. Ventetuolo, MD, MS, Assistant Professor of Medicine, Rhode Island Hospital, 593 Eddy Street, APC 7, Providence, RI 02903, USA. Tel: +1 401 444 0008; fax: +1 401 444 0094; e-mail: corey_ventetuolo@brown.edu

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